| Kings Bay Family Care | |
|
340 Charlie Smith Sr Hwy Saint Marys GA 31558-3101 | |
| (912) 882-5030 | |
| (888) 476-5235 |
| Full Name | Kings Bay Family Care |
|---|---|
| Speciality | Family Medicine |
| Location | 340 Charlie Smith Sr Hwy, Saint Marys, Georgia |
| Authorized Official Name and Position | Angelito Buencamino Lacanilao (PRESIDENT) |
| Authorized Official Contact | 9128825030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kings Bay Family Care 340 Charlie Smith Sr Hwy Saint Marys GA 31558-3101 Ph: (912) 882-5030 | Kings Bay Family Care 340 Charlie Smith Sr Hwy Saint Marys GA 31558-3101 Ph: (912) 882-5030 |
| NPI Number | 1477698611 |
|---|---|
| Provider Enumeration Date | 02/21/2007 |
| Last Update Date | 12/20/2012 |
| Medicare PECOS PAC ID | 0941192454 |
|---|---|
| Medicare Enrollment ID | O20040329000931 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477698611 | NPI | - | NPPES |
| GRP6277 | Other | GA | MEDICARE PTAN |
| 1477698611 | Other | GA | NPI |
| 083558714B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 052769 (Georgia) | Primary |
| Provider Name | Angelito B Lacanilao |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659416956 PECOS PAC ID: 4284547076 Enrollment ID: I20031107000392 |
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